| Organization Name: | MARK B CANTALES, LICENSED CLINICAL SOCIAL WORKER,PC |
| NPI Number: | 1164800553 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK CANTALES (PRESIDENT) |
| Mailing Address: | 217 Jefferson Ave Endicott |
| State: | NY US |
| Postal Code: | 137605244 |
| Phone Number: | 6073721020 |
| Fax Number: | 6072395328 |
| NPI Enumeration Date: | 05/18/2015 |
| NPI Last Update Date: | 05/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 069788R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |